In collaboration with Drs. Peter Choyke, Bradford Wood, Mike Emmert-Buck and Maria Merino, patients with a suspicion or diagnosis of prostate cancer have undergone multiplanar endorectal magnetic resonance imaging of the prostate and surrounding structures in a 3.0 Tesla magnet. Those patients with a suspicion of cancer have traditionally undergone a random sextant ultrasound directed prostate biopsy. After MRI, those that have identifiable prostate lesions undergo a tracked fused MRI ultrasound guided prostate biopsy in addition to the standard of care random biopsy. The tracked image fusion prostate biopsy platform was developed under a CRADA with the Philips corporation. Molecular profiling of the tracked cores in relation to their MRI characteristics is being designed. For those patients with intent to treat after imaging, analysis of their prostate specimens is being performed. Following radical prostatecomy, the specimen is sectioned in the axial plane using pathological whole mount sectioning. This is then compared to the representative T2 weighted axial MRI slice, dynamic contrast enhanced image, diffusion weighted image and spectroscopic image for the detection of prostate cancer. The sensitivity and specificity of multiparametric endorectal MRI for the detection of prostate cancer lesions in these patients is being determined. Examination of the microenvironment of the prostate cancer epithelium and stroma is being performed also. Drs. Ambs and his team is examining the gene and protein expression differences in the prostatectomy specimens between African-American and European-American men. Dr. Vogel is determining the feasibility of prostate stem cell development from prostatectomy specimens. Dr. Bottaro's expertise in the c-Met pathway is assisting in characterizing prostate biopsy specimens performed after imaging. Drs Neckers and Frankel are assisting in looking at xenograft models of prostate cancer and the tumors response to heat shock protein inhibitors dosed intra-tumorally and systemically. High intensity focused ultrasound is being explored as a possible method to increase drug delivery to the tumor. Drs. Schlom and Gulley have collaborated in our phase 1 clinical trial looking at the role of an intraprostatic vaccine model in patients with recurrent prostate cancer. This work is also looking into the the immunological response to prostate cancer after radical prostatectomy.